ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Author: Santiago Morales

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research has found a relationship between maternal education and children’s neurocognitive functions, but many of these studies have focused on early childhood. In addition, many previous studies have treated maternal education as something that doesn’t change over time. Few studies have explored whether a mother’s education level over the course of their child’s development might associate with neurocognitive function. ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills.

What were the study results?

A mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study suggests that early maternal education is strongly associated with later child neurocognitive outcomes. In the study, changes in maternal education were also associated with some of these outcomes. These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development.

Who was involved?

The study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

What happened during the study?

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants' cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

What happens next?

While this study suggests an association between maternal education and a child’s neurocognitive function, this research doesn’t necessarily explain the factors or mechanisms involved in that association. Future studies might further explore these factors to provide additional insights.

Where can I learn more?

Access the full journal article, “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” in Developmental Psychology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 26, 2024

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Authors: Elena Jansen, Kristine Marceau, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even in the period before birth. This study reviewed existing literature on what is known about the father’s role in child development. It highlights how a father’s history and personal characteristics before the baby is born, during pregnancy, and after birth can influence their child directly via their parenting behaviors and indirectly by influencing the child’s mother. The study also discusses how the ECHO Program can address key gaps in the literature by designing studies that address unanswered questions.

What were the study results?

The researchers reviewed the existing literature to find out which characteristics or behaviors of fathers have been connected to children’s development, especially their physical and mental health. While many studies give some information about the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the role of fathers to that of mothers. Compared to the pregnancy and pre-pregnancy stages, this study allows researchers to better understand a father’s role once a baby is born. The study team created a model to guide future inquiry and suggest methods researchers can use to help fill in some knowledge gaps in the future. One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was this study's impact?

This review of other publications reveals gaps in the research community’s understanding of the father’s role in child development. First, very little is known about the father’s role in child development before birth. The study authors noted that more studies are needed to research mothers and fathers before they have children, focusing on including fathers in a substantial way. Some of the father data collected in the existing literature was reported by the mother. This highlights a gap in the literature and the need to incorporate maternal and paternal reported data on father characteristics. Second, this review demonstrates how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health.

This study also introduces a model designed to guide other researchers in focusing on pieces of the puzzle that are currently less understood. The model may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.

Who was involved?

This literature review involved an in-depth look into existing research on the role of fathers in child development and evaluated its quality. The study focuses on three specific child outcome areas of the ECHO program: obesity, neurodevelopment, and positive health.

What happened during the study?

This literature review begins by describing data collected by the ECHO Cohort and identifying critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal. The review concludes with the presentation of a new proposed conceptual model to guide future studies considering paternal influences in ECHO and beyond.

What happens next?

With more data becoming available from the ECHO Program, information on fathers' characteristics can be connected to the rich data on family characteristics, mothers' influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Where can I learn more?

Access the full journal article, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program” in Developmental Psychobiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 27, 2023

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

Authors: Courtney K. Blackwell, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health with co-funding from the Office of Behavioral and Social Sciences Research.

Why was this study needed?

The COVID-19 pandemic and subsequent social distancing strategies may have ongoing negative effects on mental health. To measure this, ECHO researchers developed the Pandemic-related Traumatic Stress Scale (PTSS) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Acute Stress Disorder criteria. This study describes the development and validation of this new measurement tool and reports differences in pandemic-related traumatic stress in a large sample of children and adults.

What were the study results?

On average, caregivers had the highest levels of pandemic-related traumatic stress, followed by adolescents, pregnant/postpartum individuals, and children. Within these groups, the researchers found additional differences related to age and gender. Adolescents, females, and caregivers of children under 5 had higher PTSS scores on average than younger children, males, and caregivers of children 5 and older, respectively.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The researchers found that PTSS is a reliable way to measure pandemic-related traumatic stress in the context of the COVID-19 pandemic. Higher levels of pandemic-related traumatic stress were associated with greater symptoms of distress and lower life satisfaction. Unlike previous measures that capture traumatic stress reactions to a single event, the PTSS was developed to evaluate potential traumatic stress reactions to ongoing large-scale threats without defined time limits. Researchers and doctors can use this scale to distinguish general stress, depression, and anxiety from traumatic stress, helping them to identify people with higher levels of traumatic stress who may need mental health support.

Who was involved?

This study included 17,830 children and adults from 47 ECHO Cohort study sites representing all 50 states, Washington, DC, and Puerto Rico. Researchers split the sample into four groups including 1,656 pregnant or postpartum individuals; 11,483 adult caregivers; 1,795 adolescents aged 13 to 21; and caregivers who reported on 2,896 children aged 3 to 12.

What happened during the study?

Between April 2020 and August 2021, caregivers reported on behaviors observed in children aged 3 to 12, and adolescents and adults completed self-reported surveys on pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction.

What happens next?

The PTSS can be used beyond the immediate COVID-19 pandemic context. The PTSS could be adapted to evaluate reactions to other severe stressors that last a long time.

Where can I learn more?

Access the full journal article, titled “Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults,” in Psychological Assessment.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Published November 3, 2023

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

Authors: Phillip Sherlock, Maxwell Mansolf, Courtney Blackwell, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Although researchers have looked at how the COVID-19 pandemic affected the mental health of children of all ages, few studies have examined the pandemic’s impact on children and teens with pre-existing mental, emotional, behavioral, and developmental (MEBD) disabilities like depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and Autism Spectrum Disorder (ASD).

Health policies that were put in place to prevent the spread of COVID-19 caused disruption of normal activities for children and families. Schools paused in-person learning, extracurricular activities were cancelled, and stay-at-home orders meant children spent more time quarantined with family members instead of engaging with friends and peers.

This study was needed to understand how the stresses of the COVID-19 pandemic impacted life satisfaction for adolescents with disabilities, as adolescence is a critical period of social development. Researchers aimed to learn which groups of adolescents were most affected by the pandemic, so that mental health practitioners, pediatricians, and family physicians might be better informed of potential intervention and prevention practices that could be implemented to help particularly vulnerable adolescents through difficult times in the future.

What were the study results?

When exposed to certain stresses during the COVID-19 pandemic, adolescents with a history of depression, anxiety, ASD, or ADHD had lower life satisfaction compared to their peers. These stresses included decreased social connectedness, decreased family engagement, stress related to medical care access, pandemic-related traumatic stress, and living in a single-caregiver household.

This study also found that 80% of adolescents, regardless of pre-existing conditions, reported decreases in social connectedness during the COVID-19 pandemic. Although the detrimental effect of decreased social connectedness was amplified among individuals with certain pre-existing MEBD conditions, this risk factor was widespread among the majority of adolescents.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study found that adolescents with decreased social connectedness typically had lower life satisfaction across several groups with different life circumstances. However, decreased social connectedness was more harmful for individuals with disabilities. This study allowed researchers to identify the groups of adolescents with disabilities who are most vulnerable and may need additional support during future emergencies. Findings from this study also highlight the importance of interventions aimed specifically at increasing social connectedness, family engagement, and access to medical support for all adolescents, and especially for those with disabilities.

Who was involved?

This study included COVID-19 survey data collected from April 2020 to August 2021 from a sample of 1,084 adolescents ages 11–21 years old, and their caregivers. The sample included individuals with and without disabilities from seven ECHO observational research sites in the U.S.

What happened during the study?

In addition to using pre-existing ECHO Cohort data about adolescents and their families, researchers administered a COVID-19-specfic survey to better understand the physical, mental, and social impact of the pandemic on young people and their families. Data were analyzed using a machine-learning process.

What happens next?

Findings from this study showed evidence of potential differences between adolescents with disabilities and their peers in terms of life satisfaction. Future research is needed to design studies that focus on the vulnerable subgroups identified in this study. Additionally, future studies may look into the long-term effects of decreased social connections and other risks resulting from the COVID-19 pandemic during developmentally critical time periods.

Where can I learn more?

Access the full journal article, titled “Life Satisfaction for Adolescents with Developmental and Behavioral Disabilities during the COVID-19 Pandemic,” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Published October 24, 2023

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 28, 2023

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Educational Background and Child Age Influenced Experiences of Caregivers During COVID 19 Pandemic

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

Authors: Kaja Z. LeWinn, Lisa Jacobson, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

The COVID-19 pandemic and resulting public health measures presented unique challenges for families, frequently influenced by factors such as income and educational background. Yet while research has highlighted the sociodemographic factors that influenced adults’ experience, the COVID-19 pandemic generally interfered with population-based studies of children and families. However, in April 2020, the ECHO Program introduced a COVID‑19‑specific questionnaire that allowed researchers to gather information on how the pandemic and its effects on daily life were influencing the health of children. This study used ECHO data collected from April 2020 to March 2022 to examine sociodemographic differences in pandemic-related experiences.

What were the study results?

The study suggested that caregivers with less than a high school education were more likely to report challenges accessing COVID-19 testing for their children, were less likely to work remotely, and reported financial concerns and access to necessities such as food as top sources of stress. Caregivers with a master’s degree or higher, on the other hand, were more likely to name social distancing as the top source of their pandemic stress. The study also noted that caregivers with higher education had a significantly greater likelihood of having the option to work remotely. Caregivers with children between the ages of 1 and 5 reported the least support from school systems, the most difficulty finding childcare, and fewer remote learning options; were more likely to have healthcare appointments canceled due to COVID‑19 concerns, and were most concerned about how the pandemic would affect their ability to work.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study underscores the importance of understanding how children and caregivers from various backgrounds experienced the COVID-19 pandemic. This understanding can help uncover social inequities that could worsen conditions for some populations during future public health crises. These findings suggest that families with young children may be in particular need of more support related to childcare and work flexibility during future public health crises that involve school disruption.

Who was involved?

The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

What happened during the study?

Researchers measured COVID‑19 pandemic‑related experiences using three characteristics—caregiver education, child life stage, and urban or rural residence. Caregivers completed ECHO COVID‑19 surveys about their experiences during the pandemic for their children and themselves. Among children, researchers examined items related to COVID‑19 infection, access to COVID‑19 testing, changes to healthcare, and disruptions to school, preschool, or daycare. For caregivers, researchers examined remote work, childcare challenges, and their subjective ranking of pandemic‑related stressors.

What happens next?

Future research could explore the complex connections between the outcomes examined as well as the long-term impacts of COVID‑19 infection and pandemic‑related adversities for children in the ECHO Cohort over time.

Where can I learn more?

Access the full journal article, titled “Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Published August 23, 2023

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

Authors: Callie Brown, Charles Wood, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Obesity affects millions of adults, adolescents, and children in the United States. Many children in the United States enter their school years with obesity, and children with obesity at 3 years of age have a 90% probability of having overweight or obesity as an adolescent.

While existing literature suggests a relationship between parental stress and childhood body mass index (BMI), the exact way in which parental stress might affect BMI in children isn’t fully understood. There has been some disagreement in what types of stress and at what time points during childhood stress is related to child BMI. This study allowed researchers to look at a large, diverse sample of mothers and children over time to evaluate how maternal stress might be associated with the child’s BMI.

What were the study results?

This study suggests that there is no association between stress of mothers during the first year after birth and the risk of their child having obesity between ages 2 and 4.

While the study did not find an association between maternal stress levels and childhood obesity, it did reveal other information about both maternal stress and childhood BMI. In this study, the researchers found that higher stress levels were more likely among Hispanic and Black mothers, and less likely among mothers with private health insurance. Higher child BMI was more likely among Hispanic mothers, when the mothers’ BMI before birth was higher, and when the child’s birth weight was higher.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

Doctors and researchers are working to identify opportunities to prevent childhood obesity. There are many factors in the first year of life that are related to higher weight gain and earlier obesity in children, but this study’s results suggest that the level of a mother’s stress in the first year of life does not appear to be a risk factor for higher obesity risk in very young children. This may be because other factors are stronger predictors of differences in childhood BMI.

Who was involved?

The study included 1,694 mothers and their children from across the United States.

What happened during the study?

ECHO researchers analyzed data from single pregnancies where maternal stress was measured in the child’s first year of life and a child’s weight and height were measured between 2 and 4 years of age.

In addition to examining maternal stress levels and childhood BMI, researchers analyzed information including a mother’s BMI before pregnancy, the baby’s birthweight, a mother’s race, ethnicity, and age at the time of the child’s birth, and the type of health insurance they had. They also looked at the number of children a mother had and her education level.

What happens next?

Future studies may look into additional factors that can influence children’s risk for increased BMI such as BMI later in childhood, other periods or types of stress, and parent- or caregiver-measured stress.

Where can I learn more?

Access the full journal article, titled “Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program,” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 21, 2023

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

Authors: Maxwell Mansolf, Courtney K. Blackwell, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Up to 50% of children and adolescents in the United States might experience sleep problems. Poor sleep can negatively affect brain development, learning, and physical and emotional well-being. Existing studies suggest there could be a link between poor sleep outcomes in children and teens and stress experienced by their caregivers, but these studies have primarily been limited to infants and young children. In this study, researchers used ECHO’s diverse data to study this association in school-age children and teens.

What were the study results?

Children of caregivers who reported feeling stress from their life circumstances were more likely to experience sleep disturbances. This association was consistent across different groups of child and caregiver pairs studied, even after accounting for mental and physical health conditions.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This research suggests that children whose caregivers report increased perceived stress may be at higher risk for sleep issues. Screening for caregiver stress may help healthcare providers identify and plan interventions for children who may be at risk for sleep issues.

Who was involved?

The study included data from 2,641 children between ages 6 and 18 and their caregivers from 12 ECHO research sites. Most caregivers (78.6%) had at least some college education. About a third of the children (34.7%) had at least one mental health condition, and a quarter of the children (25%) had at least one physical health condition.

What happened during the study?

Researchers analyzed data provided by caregivers who completed the Perceived Stress Scale (PSS) about their own stress as well as the Child Behavior Checklist (CBCL), a common parent-reported child behavior survey, about their children’s emotional and behavioral well-being, including their sleep habits. The PSS is a widely used self-report survey that measures how much a person perceives their life as unpredictable, uncontrollable, and overloading over the previous month. To evaluate how caregiver stress affected child sleep patterns, researchers looked at responses to questions from the CBCL that addressed children’s experience with nightmares, insomnia, excessive sleep, troubled sleep, and ongoing tiredness.

What happens next?

Future sleep interventions may consider a more global approach to improving child and adolescent sleep health. Continued research on the factors that influence family health and well-being may guide interventions that address the entire family and the dynamics of the family relationship.

Where can I learn more?

Access the full journal article, titled “Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis,” in the Journal of Child and Family Studies.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 15, 2023

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Authors: Matt Kasman, et al

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

Health experts agree that sugar-sweetened drink consumption by children in the U.S. should be reduced but finding effective strategies has been a challenge. Large-scale interventions are costly and have shown limited effects. Computer modeling to explore what drives consumption in specific populations could lead to tailored strategies that yield better results.

What were the study results?

Through a computer simulation based on data collected over several years from thousands of real children, researchers found that limiting access to sugary drinks in the home could reduce childhood consumption by as much as 87%. Reducing sugar-sweetened drink availability at school and childcare facilities was also helpful. The amount of the reductions also varied between the groups of children simulated.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study highlights the importance of tailoring interventions to reduce sugar-sweetened drink consumption for different populations. Using computer models, researchers may gain more information about populations that can help to identify effective targeted interventions.

Who was involved?

This study examined data from children ages 2 to 7 years old in three ECHO research sites across the U.S. These children spent time in different environments as they grew—home, childcare, and school—where they had varying access to sugary beverages.

What happened during the study?

Researchers entered data based on children from three ECHO research sites into a computer model to recreate their sugar-sweetened beverage consumption. Based on the computer model, researchers simulated potential interventions and measured their impact on reducing consumption in different populations. Computer models can be affected by certain factors, including socioeconomic status, BMI, time spent in a specific setting, accessible beverages in the home, and access to a pediatrician.

What happens next?

In future studies, researchers plan to include older children and adjust computer models to explore the consumption of other foods and beverages with health implications.

Where can I learn more?

Access the full journal article, titled “Childhood Sugar-sweetened Beverage Consumption: An Agent-based Model of Context-specific Reduction Efforts,” in the American Journal of Preventive Medicine.

A summary of a previous study that applied computational modeling to a single ECHO research site can be found here.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 13, 2023

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Authors: Rachel L. Miller; Christine C. Johnson, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been relatively sparse. Describing the incidence rates of ARE across various pediatric populations is a critical first step for identifying potential risk factors and causes.

What were the study results?

In this study, investigators wanted to gather more information about factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma.

ARE incidence rates were highest among children ages 2-4 years old, and among non-Hispanic Black and Hispanic Black children. ARE rates were also higher among children living in the Northeast and Midwest compared to those living in the West. Children with a parental history of asthma had ARE rates 2.9 times greater compared to those with no parental history.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

Higher incidence rates of ARE among young children, non-Hispanic Black and Hispanic Black children, and children living in the Northeast and Midwest suggest that differential environmental exposures may play a significant role in the onset of recurring asthma issues in children. ARE rates are consistently higher among children with a parental history of asthma, especially for young children, which may be due to a combination of genetic, environmental, and family lifestyle factors.

Who was involved?

The research team leveraged data from 17,246 children born between 1990 and 2017 who were enrolled in 60 ECHO research sites in the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any oral corticosteroids prescribed from a health care provider. Incidence rates of ARE were based on reports of systemic (not inhaled) corticosteroid use.

Of the 4,114 children diagnosed with asthma during this study, there were 2,061 children with at least one asthma episode when they used oral steroid medication; 734 of these children had 2 or more asthma episodes with steroid medication use and met the conditions for ARE.

What happened during the study?

The researchers calculated the incidence rates of ARE for the study population as a whole, along with the rates for subsets of the population defined by the year of ARE diagnosis, the decade they were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma. The researchers followed the children from birth until they developed ARE, reached the age of 20 years or the study period ended. The study identified children who developed ARE based on at least two reports of systemic steroid medication use at any time during the entire follow-up period. Children who received asthma diagnoses before age 5 years were required to have confirmation after 5 years, either by a parent or caregiver, adolescent self-report of asthma symptoms, hospitalization, emergency department or urgent care visit for asthma, provider visits due to asthma, or asthma medication use.

What happens next?

ECHO researchers are planning new studies that examine key early environmental exposures that could contribute to ARE, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, socioeconomic status, and where children live.

Where can I learn more?

Access the full journal article, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” in The Journal of Allergy and Clinical Immunology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 25, 2023

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations